Improving abdominoplasty results: Reconstruction of the linea alba sulcus by direct fat excision

Abstract

A shallow vertical midline epigastric sulcus between rectus abdominis muscles is an attractive element of abdominal surface anatomy in slender, youthful women. Many patients presenting for abdominoplasty do not have this feature, and for those who do have it preoperatively, suture plication of anterior rectus sheath during the procedure can obliterate it. This article describes a technique to improve patient satisfaction with epigastric contour following abdominoplasty by establishing a visible linea alba sulcus. After elevation of the abdominoplasty skin flap, a precisely marked thin vertical strip of fat deep to Scarpa's fascia is carefully excised from the neoumbilical location on the flap to the deep fascia superficial to the xiphoid process. Postoperatively, the epigastrium is drained to prevent seroma, and a vertical soft bandage roll is applied on the skin over the sulcus beneath an elastic abdominal binder for gentle compression. The technique has been applied in 25 abdominoplasty procedures with good patient satisfaction. Complications included 1 epigastric seroma, 1 over-resection resulting in an unnatural appearing vertical epigastric crease, and 2 under-resections that did not achieve a visible epigastric sulcus postoperatively. When carefully performed in selected patients, creation of a linea alba sulcus by direct excision of deep fat from the abdominoplasty flap can enhance aesthetic results of abdominoplasty without increased morbidity.